胰岛素抵抗状态下2型糖尿病患者不同水平糖化血红蛋白与心肌损伤指标间关系的观察

Observation of the relationship between different levels of HbA1c and myocardial injury indicators in T2DM patients with insulin resistance

目的探讨IR状态下T2DM患者不同水平HbA1c与肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)与肌酸激酶比值(CK-MB/CK)、肌钙蛋白Ⅰ(TnⅠ)间的关系。方法选取T2DM患者168例,根据HbA1c水平分为3组,A组(HbA1c≤6.4%)56例,B组(7.1%<HbA1c≤7.8%)56例,C组(HbA1c≥9.0%)56例,检测并比较3组CK、CK-MB、CK-MB/CK、TnⅠ和胰岛素抵抗指数(HOMA-IR)。结果 B组CK-MB/CK最低,与C组比较差异有统计学意义[(0.10±0.04)vs(0.13±0.05),P=0.004];TnⅠ阳性率A组30.5%,B组32.1%,C组37.5%,差异无统计学意义(P>0.05);A组HOMA-IR最低(2.96±3.57),与B组(4.11±2.91)、C组(4.17±4.93)相比差异有统计学意义(P=0.0000)。结论 CK-MB/CK在A、B、C组中分别为(0.12±0.06)、(0.10±0.04)、(0.13±0.05),但仅据A、B组间差异有统计学意义并不能判断CK-MB/CK越小,对心肌损害越少,仍需进一步研究证实。

Objective To study the relationship between differefit levels of HbA1 c and myocardial injury indicators of T2DM patients in the state of insulin resistance. Methods A total of 168 subjects aged 55; 65 years with T2DM were recruited. They were grouped based on the level of glycosylated hemnglobin into three groups, group A （HbA1 c≤6.4%）, group B （7. 1%〈HbA1 c≤7. 8%）, and group C （HbAlc〉;9.0%）, 56 cases in each. The creatine kinase （CK）, creatine kinase isoenzyme MB （CK-MB）, CK-MB/CK, Troponin I （Tn I ）, and HOMA-IR were measured and compared. Results CK- MB/CK of group B was the lowest among three groups, and comparing with group C, the difference was significant [-（0. 10±0. 04） vs （0. 13±0. 05）, P= 0. 004]. The positive rate of Tn I of group A was 30. 5;, group B 32.1;, and group C 37.5% respectively, and the difference was not statistically significant （P〉0. 05）. HOMA-IR difference was statistically significant among the three groups. HOMA- IR was the lowest in group A （2. 96±3.57）, significantly different from that of group B （4. 11±2. 91） and group C（4. 17±4. 93）. Conclusion The CK-MB/CK of the three groups is （0. 12±0. 06）, （0. 10±0. 04）, and （0. 13 ± 0. 05） respectively. Between groups B and C there is a significant difference in CK-MB/CK. But ＂the smaller the CK-MB/CK is, the less myocardial damage is＂ may not be scientific, and further studies on it are needed to confirm.